Basic Information
| Provider Information | |||||||||
| NPI: | 1538245642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOGELSANG | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26028 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052321617 | ||||||||
| FaxNumber: | 5052627729 | ||||||||
| Practice Location | |||||||||
| Address1: | 9101 MONTGOMERY BLVD., NE | ||||||||
| Address2: | MONTGOMERY EAST FAMILY MEDICINE | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052754288 | ||||||||
| FaxNumber: | 5052754203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD2012-0674 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 200001324 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 80284582 | 05 | NM | MEDICAID | NCT3670258 | 01 | NC | MEIDCARE | OTHER |